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718 


Health  in  the  Hospital. 


[December, 


—  an'  outside,  justice.  It  's  a  narrer 
showin',  I  'm  thinkin'." 

"  My  father  was  outside,"  said  Holmes, 
some  old  bitterness  rising  up  in  his  tone, 
his  gray  eye  lighting  with  some  unre- 
venged  wrong. 

Polston  did  not  speak  for  a  moment. 

"  Dunnot  bear  malice  agin  her.  They're 
dead,  now.  It  was  n't  left  fur  her  to  judge 
him  out  yonder.  Yoh  've  yer  father's 
eyes,  Stephen,  'times.  Hungry,  pitiful, 
like  women's.  His  got  desper't'  't  th' 
last.  Drunk  hard,— died  of 't,  yoh  know. 
But  she  killed  him,  —  th'  sin  was  writ 
down  fur  her.  Never  was  a  boy  I  loved 
like  him,  when  we  was  boys." 

There  was  a  short  silence. 

"  Yoh  're  like  yer  mother,"  said  Polston, 
striving  for  a  lighter  tone.  "Here," — 
motioning  to  the  heavy  iron  jaws.  "  She 
never  —  let  go.  Somehow,  too,  she  'd 
the  law  on  her  side  in  outward  show- 
in',  an'  th'  right.  But  I  hated  religion, 
knowin'  her.  Well,  ther'  's  a  day  of  mak- 
in'  things  clear,  comin'." 

They  had  reached  the  corner  now, 
and  Polston  turned  down  the  lane. 

"Yoh  '11  think  o'  Yare's  case?"  he 
said. 

"  Yes.  •But  how  can  I  help  it," 
Holmes  said,  lightly,  "  if  I  am  like  my 
mother  here  ?  " —  putting  his  hand  to  his 
mouth. 

"  God  help  us,  how  can  yoh  ?  It  's 
harrd  to  think  father  and  mother  leave 


their  souls  fightin'  in  their  childern,  cos 
th'  love  was  wantin'  to  make  them  one 
here." 

Something  glittered  along  the  street  as 
he  spoke ;  the  silver  mountings  of  a  low- 
hung  phaeton  drawn  by  a  pair  of  Mex- 
ican ponies.  One  or  two  gentlemen  on 
horseback  were  alongside,  attendant  on  a 
lady  within.  She  turned  her  fair  face, 
and  pale,  greedy  eyes,  as  she  passed,  and 
lifted  her  hand  languidly  in  recognition 
of  Holmes.     Polston's  face  colored. 

"I  've  heered,"  he  said,  holding  out 
his  grimy  hand.  "  I  wish  yoh  well, 
Stephen,  boy.  So  '11  the  old  'oman. 
Yoh  '11  come  an'  see  us,  soon  ?  Ye  'r'  look- 
in'  fagged,  an'  yer  eyes  is  gettin'  more  like 
yer  father's.  I  'm  glad  things  is  takin' 
a  good  turn  with  yoh ;  an'  yoh  '11  never 
be  like  him,  starvin'  fur  th'  kind  wured, 
an'  havin'  to  die  without  it.  I  'm  glad 
yoh  've  got  true  love.  She  'd  a  fair  face, 
I  think.     I  wish  yoh  well,  Stephen." 

Holmes  shook  the  grimy  hand,  and  then 
stood  a  moment  looking  back  to  the  mill, 
from  which  the  hands  were  just  coming, 
and  then  down  at  the  phaeton  moving 
idly  down  the  road.  How  cold  it  was 
growing !  People  passing  by  had  a  sick- 
ly look,  as  if  they  were  struck  by  the 
plague.  He  pushed  the  damp  hair  back, 
wiping  his  forehead,  with  another  glance 
at  the  mill- women  coming  out  of  the  gate, 
and  then  followed  the  phaeton  down  the 
hill. 


HEALTH  IN  THE    HOSPITAL. 


In  preparing  to  do  the  duty  of  society 
towards  the  wounded  or  sick  soldier,  the 
first  consideration  is,  What  is  a  Military 
Hospital  ?  No  two  nations  seem  to  have 
answered  this  question  in  the  same  way ; 
yet  it  is  a  point  of  the  first  importance  to 
them  all. 

When  England  went  to  war  last  time, 
after  a  peace  of  forty  years,  the  only  idea 
in  the  minds  of  her  military  surgeons  was 


of  Regimental  Hospitals.  There  was  to 
be  a  place  provided  as  an  infirmary  for  a 
certain  number  of  soldiers ;  a  certain  num- 
ber of  orderlies  were  to  be  appointed  as 
nurses  ;  and  the  regimental  doctor  and 
hospital-sergeant  were  to  have  the  charge 
of  the  inmates.  In  each  of  these  Regi- 
mental Hospitals  there  might  be  patients 
ill  of  a  great  variety  of  disorders,  from 
the  gravest  to  the  lightest,  all  to  be  treat- 


1861.] 


Health  in  the  Hospital. 


719 


ed  by  the  same  doctor  or  doctors.  These 
doctors  had  to  make  out  statements  of  all 
the  diets,  as  well  as  all  the  medicines  re- 
quired by  their  patients,  and  send  in  their 
requisitions  ;  and  it  might  be  said  that  ar- 
rangements had  to  be  separately  made  for 
every  individual  patient  in  the  whole  ar- 
my. The  doctors  went  to  work  each  in 
his  own  way,  even  in  the  case  of  epidem- 
ics. There  was  no  knowing,  except  by 
guess,  what  diseases  were  the  most  to  be 
apprehended  in  particular  places  or  cir- 
cumstances ;  nor  what  remarkable  phe- 
nomena of  disease  were  showing  them- 
selves on  any  extended  scale ;  nor  what 
improvements  could  be  suggested  in  the 
treatment.  There  was  no  possibility  of 
such  systematic  cleanliness  and  such  ab- 
solute regularity  of  management  as  can 
be  secured  by  organization  on  a  large 
scale.  Yet  the  medical  officers  preferred 
the  plan  to  any  other.  One  plea  was,  that 
the  medical  officers  and  the  patients  were 
acquainted  with  and  attached  to  each  oth- 
er :  and  this  was  very  true.  Another  con- 
sideration was,  that  each  surgeon  liked 
to  have  his  field  of  duty  to  himself,  and 
found  it  an  advantage  to  have  a  large 
variety  of  ailments  to  treat,  to  the  con- 
stant improvement  of  his  experience. 
They  said  that  doctors  and  patients  and 
nurses  all  liked  the  Regimental  Hospi- 
tal best,  and  this  was  clear  proof  that  it 
was  the  best.  They  could  at  that  time 
say  also,  that  every  soldier  and  every 
doctor  had  a  horror  of  General  Hospi- 
tals, where  the  mortality  was  so  exces- 
sive during  the  Peninsular  War  that  be- 
ing carried  to  the  General  Hospital  was 
considered  the  same  thinw  as  being  sen- 
tenced  to  death. 

Such  being  the  state  of  opinion  and 
feeling  in  the  profession,  it  naturally  hap- 
pened that  British  army-surgeons  stuck 
to  their  Regimental  Hospitals  as  long  as 
they  could,  and,  when  compelled  to  co- 
operate in  a  General  Hospital,  made  the 
institution  as  like  as  possible  to  a  group 
of  Regimental  Hospitals,  —  resisting  all 
effective  organization,  and  baffling  all  the 
aims  of  the  larger  institution. 

In  busy  times,  no  two  Regimental  Hos- 


pitals were  alike  in  their  management, 
because  the  scheme  was  not  capable  of 
expansion.  The  surgeon  and  his  hospi- 
tal-sergeant managed  everything.  The 
surgeon  saw  and  treated  the  cases,  and 
made  out  his  lists  of  articles  wanted.  It 
was  his  proper  business  to  keep  the  books, 
—  to  record  the  admissions,  and  make  the 
returns,  and  keep  the  accounts,  and  post 
up  all  the  documents:  but  professional 
men  do  not  like  this  sort  of  woik,  when 
they  want  to  be  treating  disease  ;  and  the 
books  were  too  often  turned  over  to  the 
hospital-sergeant.  His  indispensable  busi- 
ness  was  to  superintend  the  wards,  and 
the  attendance  on  the  patients,  the  giving 
them  their  medicines,  etc.,  which  most  of 
us  would  think  enough  for  one  man  :  but 
he  had  besides  to  keep  up  the  military 
discipline  in  the  establishment, —  to  pre- 
pare the  materials  for  the  surgeon's  duty 
at  the  desk,  —  to  take  charge  of  all  the 
orders  for  the  diet  of  all  the  patients,  and 
see  them  fulfilled, — to  keep  the  record 
of  all  the  provisions  ordered  and  used  in 
every  department, —  and  to  take  charge 
of  the  washing,  the  hospital  stores,  the  fur- 
niture, the  surgery,  and  the  dispensary. 
In  short,  the  hospital-sergeant  had  to  be 
at  once  ward-master,  steward,  dispenser, 
sergeant,  clerk,  and  purveyor ;  and,  as 
no  man  can  be  a  six-sided  official,  more 
or  fewer  of  his  duties  were  deputed  to 
the  orderly,  or  to  anybody  within  call. 
Nobody  could  dispute  the  superior  econ- 
omy and  comfort  of  having  a  concentra- 
tion of  patients  arranged  in  the  wards 
according  to  their  ailments,  with  a  gen- 
eral kitchen,  a  general  laundry,  a  dispen- 
sary and  surgery,  and  a  staff  of  officials, 
each  with  his  own  distinct  business,  in- 
stead of  as  many  jacks-of-all-trades,  each 
doing  a  little  of  everything.  Yet  the  ob- 
stinacy of  the  fight  made  by  the  surgeons 
for  the  system  of  Regimental  Hospitals 
was  almost  insuperable.  Thei-e  was  no 
desire  on  any  hand  to  abolish  their  hos- 
pitals, which  must  always  be  needed  for 
slight,  and  also  for  immediately  pressing 
cases.  What  was  asked  of  them  was  to 
give  way  when  epidemics,  or  a  sudden 
influx  of  wounded,  or  protracted  cases 


720 


Health  in  the  Hospital. 


[December, 


put  a  greater  strain  upon  the  system  than 
it  would  bear. 

The  French,  meantime,  had  three  sorts 
of  hospitals,  —  the  Divisional  ones  coming 
between  the  Regimental  and  the  Gener- 
al. Only  the  very  slightest  cases  ever 
enter  their  Regimental  Hospital;  those 
which  may  last  weeks  are  referred  to 
the  Divisional ;  and  those  which  may  last 
months,  with  prospect  of  recovery,  to  the 
General  Hospital.  The  Sardinian  plan 
was  nearly  the  same.  The  Russians  had 
Divisional  Hospitals  at  various  stations; 
and  all  cases  were  carried  to  them. 

The  Regimental  Hospitals  are  wher- 
ever the  regiments  are.  The  advantage 
is,  that  aid  can  be  immediately  rendered, 
—  not  only  in  case  of  wounds,  but  of  chol- 
era, in  which  it  is  desirable  to  lay  a  pa- 
tient down  in  the  nearest  bed  to  which  he 
can  be  conveyed.  The  disadvantages  are 
the  hap-hazard  quality  of  the  site,  the  ab- 
sence of  quiet  and  seclusion,  and  the  lia- 
bility of  being  near  the  scene  of  conflict. 
These  things  cause  the  French  to  prefer 
the  Divisional  Hospital,  which,  while  still 
within  reach,  is  set  farther  back  from  the 
force,  in  a  picked  situation,  and  managed 
on  a  large  scale  and  with  nicer  exacti- 
tude. 

The  General  Hospital  is  understood  to 
be  at  the  base  of  oj)erations :  and  this  sup- 
poses, as  a  part  of  its  organization,  a 
system  of  transport,  not  only  good  of  its 
kind,  but  adequate  to  any  demands  con- 
sequent on  a  great  battle,  or  the  spread 
of  an  epidemic  in  the  camp.  The  nearer 
the  hospital  is  to  the  active  force,  the  bet- 
ter, of  course ;  but  there  are  conditions 
to  be  fulfilled  first.  It  must  be  safe  from 
the  enemy.  It  must  be  placed  in  a  per- 
manent station.  It  must  be  on  a  good 
road,  and  within  immediate  reach  of  mar- 
kets. It  ought  also  to  be  on  the  way 
home,  for  the  sake  of  the  incurable  or 
the  incapacitated  who  must  be  sent  home. 

In  the  Regimental  Hospital,  the  sur- 
geon may  be  seen  going  from  the  man 
who  has  lost  a  finger  to  a  fever  patient, — 
and  then  to  one  who  has  ophthalmia, — 
passing  on  to  a  fellow  raving  in  delirium 
tremens,  —  next  to  whom  is  a  sufferer  un- 


der bronchitis,  who  will  not  be  allowed  to 
go  out  of  doors  for  weeks  to  come  ;  and  if 
half  a  dozen  are  brought  in  with  cholera 
in  the  course  of  the  day,  the  oflicials  do 
not  know  which  way  to  turn.  It  is  possi- 
ble that  the  surgeon  may  be  found  making 
starch  over  the  kitchen  fire,  because  there 
is  nobody  at  hand  who  understands  how 
to  make  starched  bandages ;  or  he  may 
be  at  the  desk,  casting  up  columns  of  fig- 
ures, or  writing  returns,  when  he  is  ur- 
gently wanted  at  the  bedside.  Such 
things  can  hardly  happen  now ;  but  they 
have  happened  within  ten  years.  The 
Russians,  meantime,  would  be  carrying 
all  manner  of  patients  to  one  of  their  hos- 
pital-stations,—  each  sufferer  to  the  hos- 
pital of  his  own  division.  The  French 
would  leave  the  men  with  scratches  and 
slight  diarrhoea  and  delirium  tremens  in 
the  Regimental  Hospital,  —  would  send 
the  fever  and  bronchitis  and  scorbutic  pa- 
tients to  the  Divisional, —  and  any  grave- 
ly wounded,  or  rheumatic,  or  other  very 
long  cases  to  the  General  Hospital  at  the 
base  of  operations. 

Such  arrangements,  however,  are  of  no 
use,  if  the  last  be  not  so  organized  as  to 
render  it  fit  to  supply  what  the  others 
cannot  give,  and  to  answer  purposes  which 
the  others  cannot  even  propose. 

When  doctors  and  soldiers  alike  shud- 
dered at  the  mention  of  the  General  Hos- 
pital as  a  necessary  institution  at  or  near 
the  seat  of  war,  they  were  thinking  of 
what  they  had  seen  or  heard  of  during 
the  Peninsular  Campaigns.  There  were 
such  infirmaries  wherever  there  was  a 
line  of  march  in  Spain  ;  and  they  seem- 
ed to  be  all  alike.  Hospital  gangrene  set 
in  among  the  wounded,  and  fever  among 
the  sick,  so  that  the  soldiers  said,  "  To  send 
a  poor  fellow  to  the  hospital  is  to  send 
him  to  death."  Yet  there  was  nothing 
else  to  be  done  ;  for  it  was  impossible  to 
treat  the  seriously  sick  and  wounded  at 
the  spot  where  they  fell.  During  that 
war,  nearly  twice  the  number  which  com- 
posed the  army  passed  through  the  hos- 
pitals every  year ;  and  of  these  there 
were  known  deaths  to  the  amount  of  thir- 
teen thousand  five  hundred ;  and  thou-  . 


1861.] 


Health  in  the  Hospital. 


721 


sands  more  were  never  the  same  men 
again.  When  the  case  was  better  under- 
stood,—  as  during  the  last  year  in  the 
Crimea,  —  the  mortality  in  the  hospitals 
barely  exceeded  that  of  the  Guards  in 
their  barracks  at  home  I  Kecovery  had 
become  the  rule,  and  death  a  remarka- 
ble event.  General  Hospitals  had  come 
to  surpass  all  other  means  of  curing  pa- 
tients, while  fulfilling  their  own  pecuHar 
service  to  society  through  new  genera- 
tions. 

What  are  the  functions  of  General 
Hospitals,  besides  curing  the  sick  and 
wounded  ?  some  readers  may  ask,  who 
have  never  particularly  attended  to  the 
subject. 

The  first  business  of  such  institutions 
is  undoubtedly  to  restore  as  many  as  pos- 
sible of  the  sufferers  brought  into  them : 
and  this  includes  the  duty  of  bringing  in 
the  patients  in  the  most  favorable  way, 
receiving  them  in  an  orderly  ajid  quiet 
manner,  doctoring,  nursing,  feeding,  cloth- 
ing, and  cleaning  them,  keeping  their 
minds  composed  and  cheerful,  and  their 
manners  creditable,  promoting  their  con- 
valescence, and  dismissing  them  in  a  state 
of  comfort  as  to  equipment.  This  is  the 
first  duty,  in  its  many  subdivisions.  The 
next  is  to  obviate,  as  far  as  possible, 
future  disease  in  any  army.  The  third 
grows  out  of  this.  It  is  to  improve  the 
science  of  the  existing  generation  by  a 
full  use  of  the  peculiar  opportunities  of 
observation  afforded  by  the  crop  of  sick- 
ness and  wounds  yielded  by  an  army  ia 
action.  To  take  these  in  their  reverse 
order. 

There  must  be  much  to  learn  from  any 
great  assemblage  of  sickness,  under  cir- 
cumstances which  can  be  fully  ascertain- 
ed, even  at  home,  —  and  much  more  in  a 
foreign  climate.  The  medical  body  of 
every  nation  has  very  imperfect  knowl- 
edge of  classes  and  modifications  of  dis- 
eases ;  so  that  one  of  the  strongest  desires 
of  the  most  learned  physicians  is  for  an 
improved  classification  and  constantly  im- 
proving nomenclature  of  diseases ;  and 
hospital -records  afford  the  most  direct 
way  to  this  knowledge.    Thus,  while  the 


phenomena  are  frittered  away  among 
Regimental  or  unorganized  General  Hos- 
pitals, a  well-kept  record  in  each  well- 
organized  hospital  will  do  more  than  all 
other  means  to  promote  the  scientific  un- 
derstanding of  disease. 

The  statistics  of  disease  in  armies,  the 
ascertainment  of  the  numbers  who  sick- 
en and  who  die  of  particular  diseases, 
would  save  more  lives  in  future  genera- 
tions than  can  be  now  appreciated ;  but 
what  can  the  regimental  surgeon  do  to- 
wards furnishing  any  trustworthy  mate- 
rials to  such  an  inquiry  ?  A  dozen  doc- 
tors, with  each  his  smattering  of  patients, 
can  learn  and  teach  but  little  while  they 
work  apart :  whereas  a  regular  system 
of  inquiry  and  record,  in  action  where 
the  sick  are  brought  in  in  battalions,  is 
the  best  possible  agency.  Not  only  are 
these  objects  lost  when  surgeons  are  al- 
lowed to  make  the  great  hospital  a  mere 
receptacle  for  a  cluster  of  small  and  des- 
ultory hospitals,  but  the  advantages  of  a 
broad  study  of  diseases  and  their  treat- 
ment are  lost.  Inestimable  facts  of  treat- 
ment are  learned  by  watching,  at  the 
same  time  and  in  the  same  place,  a  ward 
full  of  patients  ill  of  the  same  disease. 
People  of  all  countries  know  this  by  the 
special  learning  which  their  physicians 
obtain  in  large  civil  hospitals :  and  the 
same  thing  happens  in  military  hospi- 
tals, with  the  additional  advantage  that 
the  information  and  improved  art  tend 
to  the  special  safety  of  the  future  soldiery, 
in  whatever  climate  they  may  be  called 
on  to  serve. 

There  has  long  been  some  general  no- 
tion of  the  duty  of  army-surgeons  to  re- 
cord what  they  saw  in  foreign  campaigns ; 
but  no  benefit  has  been  reaped  till  of  late. 
The  works  of  French  field-surgeons  have 
long  been  justly  celebrated;  but  I  do  not 
know  that  in  the  statistics  and  the  no- 
menclature of  disease  they  have  done 
much  more  than  others.  The  English 
surgeons  carried  or  sent  home  in  1810 
a  mass  of  papers  about  the  Walcheren 
fever,  and  afterwards  of  the  diseases  of 
the  Peninsular  force :  but  the  Director- 
General  of  the  Medical  Department  con- 


722 


Health  in  the  Hospital. 


[December, 


sidered  such  a  bulk  of  records  trouble- 
some, and  ordered  them  to  be  burnt ! 
Such  an  act  will  never  be  perpetrated 
again  :  but  directors  will  have  a  more 
manageable  mass  of  documents  to  deal 
■with  henceforth.  AVith  a  regular  system 
of  record,  at  a  central  station  of  observa- 
tion, much  more  may  be  done  with  much 
less  fatigue  to  all  parties. 

But  how  is  it  to  be  done  ?  may  well 
be  asked.  In  the  hurry  and  confusion 
of  a  war,  and  amidst  the  pressure  of  hun- 
dreds of  new  cases  in  a  day,  what  can 
the  surgeons  of  the  hospital  be  expected 
to  do  for  science,  or  even  for  the  improve- 
ment of  medical  and  surgical  practice  ?  — 
The  answer  is  seen  in  the  new  arrange- 
ments in  England,  where  a  statistical 
branch  has  been  established  in  the  Army 
Medical  Department.  Of  course,  no  one 
but  the  practising  surgeon  or  physician 
can  furnish  the  pathological  facts  in  each 
individual  case ;  but  this  is  what  every 
active  and  earnest  practitioner  does  al- 
ways and  everywhere,  when  he  sees  rea- 
son for  it.  His  note-book  or  hospital- 
journal  provides  that  raw  material  which 
the  statistical  department  is  to  arrange 
and  utilize.  The  result  will  be  that  a 
flood  of  light  will  be  cast  on  matters  af- 
fecting the  health  and  life  of  soldiers  and 
other  men,  in  regard  to  which  we  might 
Lave  gone  on  groping  for  centuries  among 
the  confusion  of  regimental  records,  with- 
out getting  what  we  wanted.  As  to  the 
method  of  proceeding,  I  may  have  some- 
thing to  say  farther  on.  Meantime,  we 
must  turn  to  the  primary  object  of  the 
institution  of  the  Military  Hospital,  — 
the  cure  of  the  wounded  and  sick  of  the 
army. 

In  the  case  of  active  war,  foreign  or 
civil,  the  General  Hospital  is  usually  an 
extemporized  establishment,  the  build- 
ing a  makeshift,  and  the  arrangements 
such  as  the  building  will  admit.  In 
Spain,  the  British  obtained  any  houses 
they  could  get ;  and  the  soldiers  were 
sometimes  crowded  into  half  a  dozen  of 
them  in  one  town.  In  the  last  war,  the 
great  buildings  at  Scutari  were  engaged 
three  months  before  they  were  wanted 


for  extensive  use ;  so  that  there  was 
plenty  of  time  for  making  them  clean, 
airy,  warm,  and  commodious,  and  for  stor- 
ing them  with  all  conveniences.  This 
was  not  done;  and  the  failure  and  its 
consequences  afford  a  lesson  by  which 
every  people  engaged  in  war  should 
profit.  A  mere  outline  of  what  was  not 
done  at  Scutari  may  be  an  indication  of 
what  should  be  done  with  all  convenient 
speed  elsewhere. 

There  was  a  catgut  manufactory  close 
at  hand,  which  filled  the  neighborhood 
with  stench.  Half  a  dozen  dead  dogs 
festered  under  the  windows  in  the  sun ; 
and  a  dead  horse  lay  in  the  aqueduct  for 
six  weeks.  The  drain-pipes  within  the 
building  were  obstructed  and  had  burst, 
spreading  their  contents  over  the  floors 
and  walls.  The  sloping  boarded  divans 
in  the  wards,  used  for  sleeping-places, 
were  found,  after  the  building  became 
crowded,  to  be  a  cover  for  a  vast  accu- 
mulation of  dead  rats,  old  rags,  and  the 
dust  of  years.  Like  all  large  stone  build- 
ings in  the  East,  it  was  intolerably  cold 
in  winter,  with  its  stagnant  air,  its  filthy 
damps,  and  its  vaultings  and  chill  floors. 
This  wonderful  building  was  very  grand- 
ly reported  of  to  England,  for  its  size 
and  capacity,  its  imposing  character,  and 
so  forth ;  and  the  English  congratulated 
themselves  on  the  luck  of  the  wounded 
in  having  such  a  hospital.  Yet,  in  the 
next  January,  fourteen  hundred  and 
eighty  were  carried  out  dead. 

It  appears  that  nobody  knew  how  to 
go  to  work.  Everybody  writes  to  some- 
body else  to  advise  them  to  "  observe  " ; 
and  there  are  so  many  assurances  that  ev- 
erybody means  to  "  observe,"  that  there 
seems  to  have  been  no  leisure  to  effect 
anything.  One  thinks  that  this,  that,  or 
the  other  should  be  attended  to ;  and  an- 
other states  that  the  matter  is  under  con- 
sideration. It  was  some  weeks  before 
anybody  got  so  far  in  definiteness  as  to 
propose  whitewash.  Somebody  under- 
stood that  somebody  else  was  intending 
to  have  the  corridors  scoured ;  and  repre- 
sentations were  to  be  made  to  the  Turkish 
authorities  about  getting  the  drain -pipes 


1861.] 


Health  in  the  Hospital, 


723 


mended.  The  Turkish  authorities  wished 
to  employ  their  own  workmen  in  putting 
in  the  stoves ;  and  on  the  18th  of  Decem- 
ber the  responsible  British  officer  hoped 
the  stoves  would  be  put  up  immediate- 
ly, but  could  not  be  certain,  as  Turkish 
workmen  were  in  question.  This  was  a 
month  after  large  companies  of  wounded 
and  sick  had  been  sent  in  from  the  seat 
of  war.  Even  then,  nothing  had  been 
done  for  ventilation,  or,  on  any  sufficient 
scale,  for  putting  the  poor  sufferers  com- 
fortably to  bed. 

These  things  confirm  the  necessity  of  a 
regulated  cooperation  between  the  sani- 
tary, the  medical,  and  the  military  offi- 
cers of  an  army.  The  sanitary  officer 
should  be  secure  of  the  services  of  engi- 
neers enough  to  render  the  hospital,  as 
well  as  the  camp,  safely  habitable.  As 
soon  as  any  building  is  taken  possession 
of  for  a  hospital,  men  and  their  tools 
should  be  at  command  for  exploring  the 
drains  and  making  new  ones,  —  for  cov- 
ering or  filling  up  ditches,  —  for  clearing 
and  purifying  the  water-courses,  and  lead- 
ing in  more  water,  if  needed,— for  remov- 
ing all  nuisances  for  a  sufficient  distance 
round,  —  and  for  improving  to  the  utmost 
the  means  of  access  to  the  house.  There 
must  be  ventilating  spaces  in  the  roof, 
and  in  the  upper  part  of  all  the  wards 
and  passages.  Every  vaulted  space,  or 
other  receptacle  of  stagnant  air,  should 
have  a  current  established  through  it. 
All  decaying  wood  in  the  building  should 
be  removed,  and  any  portion  ingrained 
with  dirt  should  be  planed  clean.  A 
due  water-supply  should  be  carried  up 
to  every  story,  and  provided  for  the  bath- 
rooms, the  wash-houses,  and  the  kitchen. 
Every  edifice  in  America  is  likely  to  be 
already  furnished  with  means  of  warmth ; 
and  the  soldiers  are  probably  in  no  dan- 
ger of  shivering  over  the  uncertain  prom- 
ise of  stoves  on  the  18th  of  December. 

Next  comes  the  consideration  of  store- 
places,  which  can  be  going  forward  while 
busy  hands  are  cleaning  every  inch  of 
ceiling,  walls,  floors,  and  windows  within. 
There  must  be  sheds  and  stables  for  the 
transport  service ;    and   a   surgery  and 


dispensary  planned  with  a  view  to  the 
utmost  saving  of  time  and  trouble,  so  that 
medicines  and  utensils  may  be  within 
reach  and  view,  and  the  freest  access  al- 
lowed to  applicants.  The  kitchens  must 
have  the  best  stoves  and  boilers,  dressers 
and  scales,  and  apparatus  of  every  kind 
that  is  known  to  the  time  ;  for  more  lives 
depend  on  perfect  food  being  adminis- 
tered with  absolute  punctuality  than  upon 
any  medical  treatment.  There  must  be 
large  and  abundant  and  airy  store-places 
for  the  provisions,  and  also  for  such  stocks 
of  linen  and  bedding  as  perhaps  nobody 
ever  dreamed  of  before  the  Crimean 
War. 

The  fatal  notions  of  Regimental  Hos- 
pital management  caused  infinite  misery 
at  Scutari.  In  entering  the  Regimental 
Hospital,  the  soldier  carries  his  kit,  or 
can  step  into  his  quarters  for  it :  and  the 
regulations,  therefore,  suppose  him  to  be 
supplied  with  shirts  and  stockings,  towel 
and  soap,  brushes  and  comb.  This  sup- 
position was  obstinately  persevered  in  at 
Scutari,  till  private  charity  had  shamed 
the  authorities  into  providing  for  the 
men's  wants.  When  the  wounded  were 
brought  from  the  Alma,  embarked  on 
crowded  transports  straight  from  the  bat- 
tle-field, how  could  they  bring  their  kits  ? 
Miss  Nightingale,  and  benevolent  visitors 
from  England,  bought  up  at  Constanti- 
nople, and  obtained  from  home,  vast  sup- 
plies of  body-  and  bed-linen,  towels,  ba- 
sins, and  water-cans ;  and  till  they  did 
so,  the  poor  patients  lay  on  a  single  blan- 
ket or  coarse  canvas  sheet,  in  their  one 
shirt,  perhaps  soaked  in  blood  and  dirt 
There  were  some  stores  in  the  hospital, 
though  not  enough ;  and  endless  difficul- 
ty was  made  about  granting  them,  lest 
any  man  should  have  brought  his  kit, 
and  thus  have  a  double  supply.  Amidst 
the  emergencies  of  active  war,  it  seems 
to  be  an  obvious  provision  that  every 
General  Hospital  should  have  in  store, 
with  ample  bedding,  body-linen  enough 
for  as  many  patients  as  can  occupy  the 
bedsj  —  the  consideration  being  kept  in 
view,  that,  where  the  sick  and  wounded 
are  congregated,  more  frequent  changes 


724 


Health  in  the  Hospital, 


[December, 


of  linen  are  necesssary  than  under  any- 
other  circumstances. 

The  excellent  and  devoted  managers 
of  the  hospitals  of  the  Union  army  need 
no  teaching  as  to  the  daily  administra- 
tion of  the  affairs  of  the  wards.  They 
■will  never  have  to  do  and  dare  the  things 
that  Miss  Nightingale  had  to  decide  up- 
on, because  they  have  happily  had  the 
privilege  of  arranging  their  hospitals  on 
their  own  principles.  They  will  not 
know  the  exasperation  of  seeing  sufferers 
crowded  together  on  a  wooden  divan 
(with  an  under-stratum  of  dead  rats  and 
rotting  rags)  while  there  is  an  out-house 
full  of  bedsteads  laid  up  in  store  under 
lock  and  key.  Not  being  disposed  to  ac- 
quiesce in  such  a  state  of  things,  and  fail- 
ing in  all  attempts  to  get  at  the  authority 
which  had  charge  of  the  locked  door, 
Miss  Nightingale  called  to  an  orderly  or 
two,  and  commanded  them  to  break  open 
the  door.  They  stared ;  but  she  said  she 
assumed  the  responsibility  ;  and  present- 
ly there  were  as  many  men  in  bed  as 
there  were  bedsteads.  Her  doctrine  and 
practice  have  always  been,  —  instant  and 
silent  obedience  to  medical  and  disciplina- 
ry orders,  without  any  qualification  what- 
ever ;  and  by  her  example  and  teach- 
ing in  this  respect  she  at  length  overcame 
the  jealousy  and  prejudices  of  authorities, 
medical  and  military  :  but  in  such  a  case 
as  the  actual  presence  of  necessaries  for 
the  sick,  sent  out  by  Government  or  by 
private  charity  for  their  use,  she  claimed 
the  benefit,  and  helped  her  patients  to  it, 
when  there  was  no  other  obstruction  in 
the  way  than  forms  and  rules  never  meant 
to  apply  to  the  case. 

What  the  jealousy  was  appeared  through 
very  small  incidents.  A  leading  medical 
officer  declared,  in  giving  evidence,  that 
the  reason  why  the  patients'  meals  were 
sometimes  served  late  and  cold,  or  half- 
cooked,  was,  that  Miss  Nightingale  and 
her  nurses  were  forever  in  the  way  in 
the  general  kitchen,  keeping  the  cooks 
from  the  fire  :  whereas  the  fact  was,  that 
neither  Miss  Nightingale  nor  any  nurse 
had  ever  entered  the  general  kitchen,  on 
any  occasion  whatever.     Their  way  was 


to  have  a  kitchen  of  their  own.  The 
very  idea  of  that  kitchen  was  savory  in 
the  wards ;  for  out  of  it  came,  always  at 
the  right  moment,  arrowroot,  hot  and  of 
the  pleasantest  consistence,  —  rice  pud- 
dings, neither  hard  on  the  one  hand  nor 
clammy  on  the  other,—  cool  lemonade  for 
the  feverish,  cans  full  of  hot  tea  for  the 
weary,  and  good  coffee  for  the  faint. 
When  the  sinking  sufferer  was  lying  with 
closed  eyes,  too  feeble  to  make  moan  or 
sign,  the  hospital  spoon  was  put  between 
his  lips,  with  the  mouthful  of  strong  broth 
or  hot  wine  which  rallied  him  till  the 
watchful  nurse  came  round  again.  The 
meat  from  that  kitchen  was  tenderer  than 
any  other  ;  the  beef-tea  was  more  savory. 
One  thing  that  came  out  of  it  was  a  les- 
son on  the  saving  of  good  cookery.  The 
mere  circumstance  of  the  boiling  water 
being  really  boiling  there  made  a  differ- 
ence of  two  ounces  of  rice  in  every  four 
puddings,  and  of  more  than  half  the  ar- 
rowroot used.  The  same  quantity  of  ar- 
rowroot which  made  a  pint,  thin  and  poor, 
in  the  general  kitchen,  made  two  pints, 
thick  and  good,  in  Miss  Nightingale's. 

Then  there  was  the  difference  in  read- 
iness and  punctuality.  Owing  to  cum- 
brous forms  and  awkward  rules,  the  or- 
derlies charged  with  the  business  were 
running  round  almost  all  day  about  the 
food  for  their  wards;  and  the  patients 
were  disgusted  with  it  at  last.  There 
were  endless  orders  and  details,  whenever 
the  monotonous  regular  diet  was  departed 
from ;  whereas  the  establishment  of  sev- 
eral regular  diets,  according  to  the  classi- 
fications in  the  wards,  would  have  simpli- 
fied matters  exceedingly.  When  every- 
thing for  dysentery  patients,  or  for  fever 
patients,  or  for  certain  classes  of  wound- 
ed was  called  "extra  diet,"  there  were 
special  forms  to  be  gone  through,  and 
orders  and  contradictions  given,  which 
threw  everything  into  confusion,  under 
the  name  of  discipline.  The  authority 
of  the  ward  would  allow  some  extra,  — • 
butter,  for  instance  ;  and  then  a  higher 
authority,  seeing  the  butter,  and  not 
knowing  how  it  came  there,  would  throw 
it  out  of  the  window,  as  "  spoiling  the 


1861.] 


Health  in  the  Hospital. 


725 


men."  Between  getting  the  orders,  and 
getting  the  meat  and  extras,  and  the  mu- 
tual crowding  of  the  messengers,  some  of 
the  dinners  were  not  put  on  the  fire  till 
an  hour  or  two  after  the  fainting  patient 
should  have  had  his  meal :  and  then,  of 
course,  he  could  not  take  it.  The  cold 
mutton-chop  with  its  opaque  fat,  the  beef 
with  its  caked  gravy,  the  arrowroot  stiff 
and  glazed,  all  untouched,  might  be  seen 
by  the  bedsides  in  the  afternoons,  while 
the  patients  were  lying  back,  sinking  for 
want  of  support.  Probably  the  dinners 
had  been  brought  up  on  a  tray,  cooling 
all  the  way  up-stairs  and  along  the  corri- 
dors ;  and  when  brought  in,  there  was 
the  cutting  up,  in  full  view  of  the  intend- 
ed eaters,  —  sometimes  on  the  orderly's 
own  bed,  when  the  tables  were  occupied. 
Under  such  a  system,  what  must  it  have 
been  to  see  the  quick  and  quiet  nurses  en- 
ter, as  the  clock  struck,  with  their  hot- wa- 
ter tins,  hot  morsels  ready-cut,  hot  plates, 
bright  knife  and  fork  and  spoon,  —  and 
all  ready  for  instant  eating !  This  was 
a  strong  lesson  to  those  who  would  learn  ; 
and  in  a  short  time  there  was  a  great 
change  for  the  better.  The  patients  who 
were  able  to  sit  at  table  were  encouraged 
to  rise,  and  dress,  and  dine  in  cheerful 
company,  and  at  the  proper  hour.  It 
was  discovered,  that,  if  an  alternation  was 
provided  of  soups,  puddings,  fish,  poul- 
try, and  vegetables,  with  the  regular  beef 
dinner,  the  great  mass  of  trouble  about 
extras  was  swept  away  at  once  ;  for  these 
varieties  met  every  case  in  hospital  ex- 
cept the  small  number  which  required 
slops  and  cordials,  or  something  very  un- 
usual. By  this  clearance,  time  was  saved 
to  such  an  extent  that  punctuality  be- 
came possible,  and  the  refusal  of  food  al- 
most ceased. 

All  these  details  point  to  the  essential 
badness  of  the  system  of  requisitions.  In 
the  old  days,  when  war  was  altogether  a 
mass  of  formalities,  —  and  in  peace  times, 
when  soldiers  and  their  guardians  had 
not  enough  to  do,  and  it  was  made  an 
object  and  employment  to  save  the  na- 
tional property  by  hedging  round  all  ex- 
penditure of  that  property  with  difficul- 


ties, the  system  of  requisitions  might  suit 
the  period  and  the  parties.  Amidst  the 
rapid  action  and  sharp  emergencies  of 
war  it  is  out  of  place.  It  was  found  in- 
tolerable that  nothing  whatever  could  be 
had,  —  not  a  dose  of  medicine,  nor  a 
candle,  nor  a  sheet,  nor  a  spoon  or  dish, 
nor  a  bit  of  soap, —  without  a  series  of  per- 
mits, and  applications,  and  orders,  and 
vouchers,  which  frittered  away  the  pre- 
cious hours,  depressed  the  sick,  worried 
their  nurses,  and  wasted  more  of  money's 
worth  in  official  time,  paper,  and  expen- 
sive cross-purposes  than  could  possibly 
have  been  saved  by  all  the  ostentatious 
vigilance  of  the  method.  The  deck-loads 
of  vegetables  at  Balaklava,  thrown  over- 
board because  they  were  rotten  before 
they  were  drawn,  were  not  the  only 
stores  wasted  for  want  of  being  asked  for. 
When  the  Scutari  hospitals  had  become 
healthy  and  comfortable,  there  was  a  thor- 
ough opening-out  of  all  the  stores  which 
had  before  been  made  inaccessible  by 
forms.  No  more  bedsteads,  no  more  lime- 
juice,  no  more  rice,  no  more  beer,  no 
more  precious  medicines  were  then  lock- 
ed away,  out  of  the  reach  or  the  knowl- 
edge of  those  who  were  d^-ing,  or  seeing 
others  die,  for  want  of  them. 

One  miserable  consequence  of  the 
cumbrous  method  was,  that  there  was  no 
certainty  at  any  hour  of  some  essential 
commodity  not  falling  short.  It  would 
have  been  a  dismal  day  for  the  most  suf- 
fering of  the  patients  when  there  was  not 
fuel  enough  to  cook  "  extras,"  if  Miss 
Nightingale  had  not  providently  bought 
four  boat-loads  of  wood  to  meet  such  a 
.  contingency.  It  was  a  dreadful  night  in 
the  hospital,  when,  as  cholera  patients 
were  brought  in  by  the  score,  the  sur- 
geons found  there  were  no  candles  to  be 
had.  In  that  disease,  of  all  maladies, 
they  had  to  tend  their  patients  in  the 
dark  all  night;  and  a  more  shocking 
scene  can  scarcely  be  conceived. 

Every  great  influx  of  patients  was  ter- 
rible, whether  from  an  epidemic  or  after 
a  battle  ;  but  experience  and  devoted- 
ness  made  even  this  comparatively  easy 
before  the  troops  turned  homewards. 


726 


Health  in  the  Hospital. 


[December, 


The  arrival  of  a  transport  was,  perhaps, 
the  first  intimation  of  the  earlier  battles. 
Then  all  was  hurry-skurry  in  the  hospi- 
tals ;  everybody  was  willing  to  help,  but 
the  effectual  organization  was  not  yet 
ready. 

Of  every  hundred  on  board  the  trans- 
port, an  average  of  ten  had  died  since 
leaving  the  Crimea.  The  names  and 
causes  of  death  of  these  men  ought  to  be 
recorded  ;  but  the  surgeons  of  the  trans- 
port are  wholly  occupied  in  despatching 
their  living  charge  to  the  hospital ;  and 
the  surgeons  there  have  enough  to  do  in 
receiving  them.  Attempts  are  made  to 
obtain  the  number  and  names  and  in- 
juries of  the  new  patients  :  there  may  or 
may  not  be  a  list  furnished  from  the 
ship  ;  and  the  hospital  surgeons  inquire 
from  bed  to  bed :  but  in  such  a  scene 
mistakes  are  sure  to  arise ;  and  it  was 
found,  in  fact,  that  there  was  always  more 
or  less  variation  between  the  numbers 
recorded  as  received  or  dead  and  the 
proper  number.  No  one  could  wonder 
at  this  who  had  for  a  moment  looked  up- 
on the  scene.  The  poor  fellows  just  ar- 
rived had  perhaps  not  had  their  clothes 
off  since  they  were  wounded  or  were 
seized  with  cholera,  and  they  were  steep- 
ed in  blood  and  filth,  and  swarming  with 
vermin.  To  obtain  shirts  and  towels  was 
hard  work,  because  it  had  to  be  proved 
that  they  brought  none  with  them.  They 
were  laid  on  the  floor  in  the  corridors,  as 
close  as  they  could  be  packed,  thus  breath- 
ing and  contaminating  the  air  which  was 
to  have  refreshed  the  wards  within.  If 
laid  upon  so-called  sheets,  they  entreated 
that  the  sheets  might  be  taken  away  ;  for 
they  were  of  coarse  canvas,  intolerable 
to  the  skin.  Before  the  miserable  com- 
pany could  be  fed,  made  clean,  and  treat- 
ed by  the  surgeons,  many  were  dead; 
and  a  too  large  proportion  were  never  to 
leave  the  place  more,  though  struggling 
for  a  time  with  death.  It  was  amidst  such 
a  scene  that  Florence  Nightingale  refus- 
ed to  despair  of  five  men  so  desperately 
wounded  as  to  be  set  aside  by  the  sur- 
geons. The  surgeons  were  right.  As 
they  said,  their  time  was  but  too  little  for 


the  cases  which  were  not  hopeless.  And 
Florence  Nightingale  was  right  in  find- 
ing time,  if  she  could,  to  see  whether 
there  was  really  no  chance.  She  ascer- 
tained that  these  five  were  absolutely 
given  over ;  and  she  and  her  assistants 
managed  to  attend  to  them  through  the 
night.  She  cleaned  and  comforted  them, 
and  had  spoonfuls  of  nourishment  ready 
whenever  they  could  be  swallowed.  By 
the  morning  round  of  the  surgeons,  these 
men  were  ready  to  be  operated  upon ; 
and  they  were  all  saved. 

It  would  have  been  easier  work  at  a 
later  period.  Before  many  months  were  • 
over,  the  place  was  ready  for  any  num- 
ber to  be  received  in  peace  and  quiet- 
ness. Instead  of  being  carried  from  one 
place  to  another,  because  too  many  had 
been  sent  to  one  hospital  and  too  few  to 
another,  the  poor  fellows  were  borne  in 
the  shortest  and  easiest  way  from  the 
boat  to  their  beds.  They  were  found 
eager  for  cleanliness ;  and  presently  they 
were  clean  accordingly,  and  lying  on  a 
good  bed,  between  clean,  soft  sheets. 
They  did  not  come  in  scorbutic,  like  their 
predecessors  ;  and  they  had  no  reason  to 
drea^  hospital  gangrene  or  fever.  Every 
floor  and  every  pane  in  the  windows  was. 
clean ;  and  the  air  came  in  pure  from 
the  wide,  empty  corridors.  There  was 
a  change  of  linen  whenever  it  was  desir- 
ed ;  and  the  shirts  came  back  from  the 
wash  perfectly  sweet  and  fresh.  The 
cleaning  of  the  wards  was  done  in  the 
mornings,  punctually,  quickly,  quietly, 
and  thoroughly.  The  doctors  came  round, 
attended  by  a  nurse  who  received  the 
orders,  and  was  afterwards  steady  in  the 
fulfilment  of  them.  The  tables  of  the 
medicines  of  the  day  were  hung  up  in 
the  ward ;  and  the  nurse  went  round  to 
administer  them  with  her  own  hand. 
Where  she  was,  there  was  order  and 
quietness  all  day,  and  the  orderlies  were 
worth  twice  as  much  as  before  the  wom- 
en came.  Their  manners  were  better"; 
and  they  gave  their  minds  more  to  their 
business.  The  nurse  found  time  to  suit 
each  patient  who  wished  It  with  a  book 
or  a  newspaper,  when  gifts  of  that  sort 


1861.] 


Heallk  in  the  Hospital, 


ni 


arrived  from  England.  Kind  visitors  sat 
by  the  beds  to  write  letters  for  the  patients, 
undertaking  to  see  the  epistles  forwarded 
to  England.  When  the  invalids  became 
able  to  rise  for  dinner,  it  was  a  turning- 
point  in  their  case ;  and  they  were  soon 
getting  into  the  apartment  where  there 
were  games  and  books  and  meetings  of 
old  comrades.  As  I  have  said  before, 
those  who  died  at  these  hospitals  were 
finally  scarcely  more  than  those  who 
died  in — not  the  hospitals — but  the  bar- 
racks of  the  Guards  at  home. 

What  were  the  changes  In  organization 
needed  to  produce  such  a  regeneration 
as  this  ? 

They  were  such  as  must  appear  to 
Americans  very  simple  and  easy.  The 
wonder  will  be  rather  that  they  were 
necessary  at  last  than  that  they  should 
have  been  effected  with  any  difficulty. 
But  Americans  have  never  known  what 
it  is  to  have  a  standing  army  as  a  long- 
established  and  prominent  national  Insti- 
tution ;  and  they  can  therefore  hardly 
conceive  of  the  strength  of  the  class- 
spirit  which  grows  up  in  the  various  de- 
partments of  the  military  organization. 
This  jealousy,  egotism,  and  stiffness  of 
prejudice  were  much  aggravated  by  the 
long  peace,  in  which  a  great  rusting  of 
the  apparatus  of  the  system  took  place, 
without  at  all  Impairing  the  complacency 
of  those  who  formed  a  part  of  It.  The 
old  medical  officers  were  incapable,  pe- 
dantic, and  jealous ;  and  no  proper  rela- 
tion had  ever  been  established  between 
them  and  the  military  authorities.  The 
imbecility  of  the  system  cost  the  lives  of 
others  than  the  soldiers  who  died  in  hos- 
pital. Brave  men  arose,  as  in  all  such 
crises,  to  bear  the  consequences  of  other 
men's  mistakes,  and  the  burden  of  expos- 
ing them ;  and  several  physicians  and 
surgeons  died,  far  from  home.  In  the  effort 
to  ameliorate  a  system  which  they  found 
unworkable.  The  greatest  benefactor  in 
exhibiting  evils  and  suggesting  remedies, 
Dr.  Alexander,  lived  to  return  home,  and 
instigate  reforms,  and  receive  the  honors 
which  were  his  due  ;  but  he  soon  sank 
under  the   consequences   of  his   labors. 


So  did  Lord  Herbert,  the  Secretary  of 
War,  to  whom,  in  conjunction  with  Miss 
Nightingale,  the  British  army,  at  home, 
in  India,  and  everywhere,  owes  its  re- 
demption from  special  sickness  and  undue 
mortality.  In  America  the  advantages 
may  be  enjoyed  without  tax  or  drawback. 
The  citizens  are  accustomed  to  organize 
themselves  for  action  of  all  sorts ;  and 
no  stiff-necked  classes  stand  in  the  way 
of  good  management.  The  difficulty  in 
America  must  rather  be  to  understand 
how  anything  so  perverse  as  the  manage- 
ment of  British  military  hospitals  ten  years 
ago  can  have  existed  to  so  late  a  date. 

It  was  supposed,  ten  years  since,  that 
there  must  be  nine  separate  departments 
in  every  Military  General  Plospltal,  and 
the  officials  bore  titles  accordingly;  but 
there  was  such  an  odd  confusion  in  their 
functions  that  every  one  of  the  nine  was 
often  seen  doing  the  business  of  some  oth- 
er. The  medical  officers  were  drawing 
corks  and  tasting  wines  and  Inspecting 
provisions,  when  they  should  have  been 
by  the  bedside.  The  purveyor  was  count- 
ing the  soldiers'  money,  and  noting  its 
amount,  when  he  should  have  been  mar- 
keting, or  ordering  the  giving  out  of  the 
provisions  for  the  day.  The  paymaster 
could  scarcely  find  time  to  discharge  the 
bills,  so  much  was  his  day  filled  up  with 
doing  eternal  sums  about  the  stoppages 
in  the  pay  of  the  patients.  There  were 
thirteen  kinds  of  stoppages  in  the  army, 
three  of  which  were  for  the  sick  In  hos- 
pital :  the  paymaster  could  never  be  quite 
certain  that  he  had  reckoned  rightly  with 
every  man  to  the  last  penny  ;  the  men 
were  never  satisfied ;  and  the  confusion 
was  endless.  The  commissariat,  the  pur- 
veyor, and  the  paymaster  were  all  kept 
waiting  to  get  their  books  made  up,  while 
soldiers  were  working  the  sums,  —  being 
called  from  their  proper  business  to  help 
about  the  daily  task  of  the  stoppages. 
Why  there  should  not  be  one  uniform 
stoppage  out  of  the  pay  of  men  in  hos- 
pital no  person  of  modern  ideas  could 
see ;  and  the  paymaster's  toils  would  have 
been  lessened  by  more  than  one-half,  if 
he  had  had  to  reckon  the  deduction  from 


728 


Health  in  the  Hospital. 


[December, 


the  patients'  pay  at  threepence  or  four- 
pence  each,  all  round,  instead  of  having 
to  deal  with  thousands  per  day  individu- 
ally, under  three  kinds  of  charge  upon 
the  pay. 

The  commandant's  post  was  the  hard- 
est,—  he  being  supposed  to  control  every 
province,  and  have  every  official  under 
his  orders,  and  yet  being  powerless  in  re- 
gard to  two  or  three  departments,  the 
business  of  which  he  did  not  understand. 
The  officers  of  those  departments  went 
each  his  own  way ;  and  all  unity  of  action 
in  the  establishment  was  lost.  This  is 
enough  to  say  of  the  old  methods. 

In  the  place  of  them,  a  far  simpler  sys- 
tem was  proposed  at  the  end  of  the  war. 
The  eternal  dispute  as  to  whether  the 
commandant  should  be  military  or  medi- 
cal, a  soldier  or  a  civilian,  was  set  aside 
by  the  decision  that  he  should  be  simply 
the  ablest  administrator  that  could  be 
found,  and  be  called  the  Governor,  to 
avoid  the  military  title.  Why  there  should 
be  any  military  management  of  men  who 
are  sick  as  men,  and  not  as  soldiers,  it  is 
difficult  to  see ;  and  when  the  patients  are 
about  to  leave  the  hospital,  a  stated  su- 
pervision from  the  adjutant-general's  de- 
partment is  all  that  can  be  required.  Thus 
is  all  the  jealousy  between  military  and 
medical  authority  got  rid  of.  The  Gov- 
ernor's authority  must  be  supreme,  like 
that  of  the  commandant  of  a  fortress,  or 
the  commander  of  a  ship.  He  will  not 
want  to  meddle  in  the  doctors'  profession- 
al business ;  and  in  all  else  he  is  to  be 
paramount,  —  being  himself  responsible 
to  the  War-Office.  The  office,  as  thus 
declared,  is  equivalent  to  three  of  the 
nine  old  ones,  namely,  the  Commandant, 
the  Adjutant-General,  and  the  Quarter- 
master-General. 

Next  to  the  Governor,  the  Chief  Med- 
ical Officer  must  be  the  most  important 
man  in  the  establishment.  He  is  to  be 
concerned  with  professional  business  only, 
and  to  see  that  all  under  him  are  to  be 
devoted  in  the  same  way.  For  this  pur- 
pose there  must  be  an  end  to  the  system 
of  requisitions.  There  must  be  a  Stew- 
ard, taking  his  orders  from  the  Governor 


alone,  and  administering  a  simple  and 
liberal  system  of  diets  and  appliances  of 
all  sorts.  It  is  his  business  to  provide 
everything  for  the  consumption  of  the 
establishment,  and  to  keep  the  contrac- 
tors up  to  their  duty.  The  Treasurer's 
function  speaks  for  itself.  All  the  ac- 
counts and  payments  under  the  Govern- 
or's warrant  are  in  his  charge. 

There  is  one  more  office,  rendered  ne- 
cessary by  the  various  and  active  service 
always  going  on,  —  the  superintendent 
of  that  service,  or  Captain  of  the  Wards. 
He  is  to  have  the  oversight  of  the  order- 
lies, cooks,  washers,  and  storekeepers  ;  he 
is  to  keep  order  throughout  the  house  ; 
and  he  is  to  be  referred  to  in  regard  to 
everything  that  is  wanted  in  the  wards, 
except  what  belongs  to  the  department 
of  the  medical  officers  or  the  steward. 

As  for  the  medical  department,  there 
is  now  a  training  provided  for  such  sol- 
diers as  wish  to  qualify  themselves  for 
hospital  duty.  Formerly,  the  hospital 
was  served  by  such  men  as  the  military 
officers  thought  fit  to  spare  for  the  pur- 
pose ;  and  they  naturally  did  not  send 
the  best.  These  men  knew  nothing 
of  either  cleaning  wards  or  nursing  pa- 
tients. Their  awkwardness  in  sweeping 
and  scouring  and  making  beds  was  ex- 
treme ;  and  they  were  helpless  in  case 
of  anything  being  wanted  to  a  blister  or 
a  sore.  One  was  found,  one  day,  ear- 
nestly endeavoring  to  persuade  his  pa- 
tient to  eat  his  poultice.  It  is  otherwise 
now.  The  women,  where  there  are  any, 
ought  to  have  the  entire  charge  of  the 
sweeping  and  cleaning, — the  housemaid's 
work  of  the  wards ;  and  as  to  the  rest, 
the  men  of  the  medical-staff  corps  have 
the  means  of  learning  how  to  dress  a 
blister,  and  poultice  a  sore,  and  apply 
plasters,  lint,  and  bandages,  and  admin- 
ister medicine,  and  how  to  aid  the  sick 
in  their  ablutions,  in  getting  their  meals 
with  the  least  fatigue,  and  so  on. 

Of  female  nurses  it  is  not  necessary  to 
say  much  in  America,  any  more  than  in 
England  or  France.  They  are  not  ad- 
missible into  Regimental  Hospitals,  in  a 
general  way ;  but  in  great  military  and 


1861.] 


Health  in  the  Hospital. 


729 


civil  hospitals  they  are  a  priceless  treas- 
ure. 

The  questions  in  regard  to  them  are 
two.  Shall  their  office  be  confined  to 
the  care  of  the  linen  and  stores,  and  the 
supplying  of  extra  diets  and  comforts  ? 
If  admitted  to  officiate  in  the  wards,  how 
far  shall  that  function  extend  ? 

In  England,  there  seems  to  be  a  strong 
persuasion  that  some  time  must  elapse, 
and  perhaps  a  generation  of  doctors  must 
pass  away,  before  the  ministration  of  fe- 
male nurses  in  military  hospitals  can  be- 
come a  custom,  or  even  an  unquestioned 
good.  No  rationfil  person  can  doubt 
what  a  blessing  it  would  be  to  the  pa- 
tients to  have  such  nurses  administer 
nourishment,  when  the  rough  orderlies 
would  not  have  discernment  or  patience 
tO'  give  the  frequent  spoonful  when  the 
very  life  may  hang  upon  it.  Nobody 
doubts  that  wounds  would  be  cleans- 
ed which  otherwise  go  uncleansed, — 
that  much  irritation  and  suffering  would 
be  relieved  which  there  are  otherwise 
no  hands  to  undertake.  Nobody  doubts 
that  many  lives  would  be  saved  in  every 
great  hospital  from  the  time  that  fevered 
frames  and  the  flickerinffs  of  struo-o-llnor 
vitahty  were  put  under  the  charge  of  the 
nurses  whom  Nature  made.  But  the  dif- 
ficulties and  risks  are  great.  On  the 
whole,  it  seems  to  be  concluded  by  those 
who  know  best,  that  only  a  few  female 
nurses  should  be  admitted  into  military 
and  naval  hospitals  :  that  they  should  be 
women  of  mature  age  and  ascertained 
good  sense,  thoroughly  trained  to  their 
business :  that  they  should  be  the  women 
who  have  been,  or  who  would  be,  the 
head  nurses  in  other  hospitals,  and  that 
they  should  be  paid  on  that  scale :  that 
they  should  have  no  responsibility,  — 
being  wholly  subject  to  the  surgeons  in 
ward  affairs,  and  to  their  own  superin- 
tendent in  all  others  :  that  no  enthusiasts 
or  religious  devotees  should  be  admitted, 
—  because  that  very  qualification  shows 
that  they  do  not  understand  the  busi- 
ness of  nursing :  that  everything  that  can 
be  as  well  done  by  men  should  be  done 
by  trained  orderhes :  that  convalescents 

VOL.  VIII.  47 


should,  generally  speaking,  be  attended 
on  by  men,  —  and  if  not,  that  each  fe- 
male nurse  of  convalescents  should  have 
a  hundred  or  so  in  her  charge,  whereas 
of  the  graver  cases  forty  or  fifty  are  as 
many  as  one  nurse  can  manage,  with  any 
amount  of  help  from  orderlies.  These 
proposals  give  some  idea  of  what  is  con- 
templated with  regard  to  the  ordinary 
nurses  in  a  General  Military  Hospital. 
The  superintendent  of  the  nurses  in  each 
institution  must  be  a  woman  of  high  qual- 
ity and  large  experience.  And  she  will 
show  her  good  sense,  in  the  first  place,  by 
insisting  on  a  precise  definition  of  her 
province,  that  there  may  be  no  avoidable 
ill-will  on  the  part  of  the  medical  officers, 
and  no  cause  of  contention  with  the  cap- 
tain of  service,  or  whatever  the  adminis- 
trator of  the  interior  may  be  called.  She 
must  have  a  decisive  voice  in  the  choice 
of  her  nurses ;  and  she  will  choose  them 
for  their  qualifications  as  nurses  only,  af- 
ter being  satisfied  as  to  their  character, 
health,  and  temper. 

No  good  nurse  can  endure  any  fuss 
about  her  work  and  her  merits.  Enthu- 
siasts and  devotees  find  immediately  that 
they  are  altogether  out  of  place  in  a  hos- 
pital,— or,  as  we  may  now  say,  they  would 
find  this,  if  they  were  ever  to  enter  a  hos- 
pital :  for,  in  fact,  they  never  now  arrive 
there.  The  preparation  brings  them  to 
a  knowledge  of  themselves ;  and  the  two 
sorts  of  women  who  really  and  perma- 
nently become  nurses  are  those  who  de- 
sire to  make  a  living  by  a  useful  and  val- 
ued and  well-paid  occupation,  and  those 
who  benevolently  desire  to  save  life  and 
mitigate  suffering,  with  such  a  temper  of 
sobriety  and  moderation  as  causes  them 
to  endure  hardship  and  ill-usage  with 
firmness,  and  to  dislike  praise  and  ce- 
lebrity at  least  as  much  as  hostility  and 
evil  construction.  The  best  nurses  are 
foremost  in  perceiving  the  absurdity  and 
disagreeableness  of  such  heroines  of  ro- 
mance as  flourished  in  the  press  seven 
years  ago,  —  young  ladies  disappointed 
in  love,  who  went  out  to  the  East,  found 
their  lovers  in  hospital,  and  went  off  with 
them,  to  be  happy  ever  after,  without  any 


730 


A  Story  of  Thanksgiving- Time. 


[December, 


anxiety  or  shame  at  deserting  their  pa- 
tients in  the  wards  without  leave  or  no- 
tice. Not  of  this  order  was  Florence 
Nightingale,  whose  practical  hard  work, 
personal  reserve,  and  singular  adminis- 
trative power  have  placed  her  as  high 
above  impeachment  for  feminine  weak- 
nesses as  above  the  ridicule  which  com- 
monly attends  the  striking  out  of  a  new 
course  by  man  or  woman.  Those  who 
most  honor  her,  and  most  desire  to  follow 
her  example,  are  those  who  most  stead- 
ily bring  their  understandings  and  their 
hearts  to  bear  upon  the  work  which  she 


began.  Her  ill-health  has  withdrawn  her 
from  active  nursing  and  administration ; 
but  she  has  probably  done  more  towards 
the  saving  of  life  by  working  in  connec- 
tion with  the  War-Office  in  private  than 
by  her  best-known  deeds  in  her  days  of 
health.  Through  her,  mainly,  it  is  that 
every  nation  has  already  studied  with 
some  success  the  all-important  subject  of 
Health  in  the  Camp  and  in  the  Hospi- 
tal. It  now  lies  in  the  way  of  Ameri- 
can women  to  take  up  the  office,  and, 
we  may  trust,  to  "  better  the  instruc- 
tion." 


A   STORY   OF   THANKSGIVING-TIME. 


Old  Jacob  Newell  sat  despondent  be-  " 
side  his  sitting-room  fire.  Gray-haired 
and  venerable,  with  a  hundred  hard  lines, 
telling  of  the  work  of  time  and  struggle 
and  misfortune,  furrowing  his  pale  face, 
he  looked  the  incarnation  of  silent  sorrow 
and  hopelessness,  waiting  in  quiet  meek- 
ness for  the  advent  of  the  King  of  Ter- 
rors :  waiting,  but  not  hoping,  for  his 
coming ;  without  desire  to  die,  but  with 
no  dread  of  death. 

At  a  short  distance  from  him,  in  an  an- 
cient straight-backed  rocking-chair,  dark 
with  age,  and  clumsy  in  its  antique  carv- 
ings, sat  his  wife.  Stiffly  upright,  and 
with  an  almost  painful  primness  in  dress 
and  figure,  she  sat  knitting  rapidly  and 
with  closed  eyes.  Her  face  was  rigid  as 
a  mask ;  the  motion  in  her  fingers,  as  she 
plied  her  needles,  was  spasmodic  and  ma- 
chine-like ;  the  figure,  though  quiet,  wore 
an  air  of  iron  repose  that  was  most  un- 
easy and  unnatural.  Still,  through  the 
mask  and  from  the  figure  there  stole  the 
aspect  and  air  of  one  who  had  within  her 
deep  wells  of  sweetness  and  love  which  on- 
ly strong  training  or  power  of  education 
had  thus  covered  up  and  obscured.  She 
looked  of  that  stern  Puritanical  stock 
whose  iron  will  conquered  the  severity 


of  New  England  winters  and  overcame 
the  stubbornness  of  its  granite  hills,  and 
whose  idea  of  a  perfect  life  consisted  in 
the  rigorous  discharge  of  all  Christian  du- 
ties, and  the  banishment,  forever  and  at 
all  times,  of  the  levity  of  pleasure  and  the 
folly  of  amusement.  She  could  have  walk- 
ed, if  need  were,  with  composure  to  the 
stake ;  but  she  could  neither  have  joined 
in  a  game  at  cards,  nor  have  entered  into 
a  romp  with  little  children.  All  this  was 
plainly  to  be  seen  in  the  stern  repose  of 
her  countenance  and  the  stiff  harshness 
of  her  figure. 

Upon  the  stained  deal  table,  standing 
a  little  in  the  rear  and  partially  between 
the  two,  reposed  an  open  Bible.  Between 
its  leaves  lay  a  pair  of  large,  old-fashion- 
ed, silver-bowed  spectacles,  which  the  hus- 
band had  but  recently  laid  there,  after 
reading  the  usual  daily  chapter  of  Holy 
Writ.  He  had  ceased  but  a  moment  be- 
fore, and  had  laid  them  down  with  a 
heavy  sigh,  for  his  heart  to-day  was  sore- 
ly oppressed;  and  no  wonder;  for,  fol- 
lowing his  gaze  around  the  room,  we  find 
upon  the  otherwise  bare  walls  five  -sad 
mementos  of  those  who  had  "gone  be- 
fore,"—  five  coarse  and  unartistic,  but 
loving  tributes  to  the  dead. 


■  '  ■•  A 

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Mm 

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mm 


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r*1 


^yA^i^iiiffi 


'^.jM>:ix»  ■'y^^^  :I^s>  ;T::^r 


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^ir^-:-^__2».  J«f*.. 


-^^-^'^i^J^.,. 


5,i>T3tS>  . 


^^^^^-Si? 


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>  •^*^  ^^^*= 


